DPG - a new way toadjust the office desk

Making office workers healthier:
A public health intervention making office workers use
their height-adjustable office desks more,
conducted for LINAKLINAK.COM/DESKLINE

/KL.7. Making office workers healthier: A public health intervention making office workers use their height-adjustable office desks more, conducted for LINAK® 2017

Making office workers healthier:
A public health intervention making office workers use their height-adjustableoffice desks more, conducted for LINAK®

Author: /KL.7, a European behavioral design agency, Copenhagen, Denmark. www.kl7.dk

Abstract
Background: Sitting down several hours
a day is bad for our health. Studies haveshown that providing office workers with aheight-adjustable office desk can decrease
hours of sitting at work. However, eventhough provided with a height-adjustableoffice desk, not all office workers use it. As
the systematic mapping of human behavior
through empirical research throughout thelast 40 years have shown by the likes of
Kahnemann, Twersky, Akerloff and Shiller, inbehavioral economy, humans are not necessarily build for following through on mostintensions. This has been named the action/
intention gap, and it may very likely be oneof the root-causes of office workers withheight-adjustable office desks are not using
them as much as the initially wanted to.
Objectives: LINAK A/S wanted to design
and test solutions that could help officeh/day

Recommendations for office
workers that are mainly desk
based are at least 2 hours/day. (p. 6)

2workers use their desks more. Especially
office workers that didn’t use or used theirheight-adjustable desk 20 % or less of thetime (defined as light users).
Method: Two different reminder-interventions were tested in 3 different workplaces.
Data was collected through a software
measuring if the desk was in a standing or
sitting position, and whether the person
was at their desk. Baseline as well as theintervention data was collected in periodsof 2-3 weeks.
Results: For light users, we see an increasein time standing from 36.3 min/day inbaseline to 78.9 min/day during the intervention. Also, equivalent to standing 7.6% during an 8-hour workday at baseline
and 16.4 % a day during the intervention
period. Only looking at office workers not

2x
Reminders doubled the standingtime of light users. The time increased from 36.6 min/day to 78.9
min/day.

using their height-adjustable desk duringbaseline (< 2 % of the time) we found
an additional effect of 12.3 min/day. No
statistically significant results were foundfor heavy users (standing more than 20 %of the time), and no difference in effect was
found of the two interventions tested.
Conclusion: LINAK A/S wanted to test
reminders that would increase the odds ofoffice workers using their height-adjustableoffice desks. Both interventions tested in
the current pilot study showed promising
effect on increasing standing time for office
workers using their desk 20 % or less of thetime to begin with.

/KL.7. Making office workers healthier: A public health intervention making office workers use their height-adjustable office desks more, conducted for LINAK® 2017

Contents

1.0 Background..............................................................................

4

2.0 Behavioral Design....................................................................
2.1 Interventions.................................................................................
2.2 Intervention sites and period.........................................................

6
7
8

3.0 Method............................................................................................ 9
3.1 Study design................................................................................. 9
3.2 Data collection.............................................................................. 10
3.3 Data management........................................................................ 11
3.4 Statistical analyses........................................................................ 12
3.5 Qualitative insights that might affects behavior............................. 13
4.0 Results............................................................................................. 13
4.1 Overall results......................................................................... 14
4.2 Qualitative evaluation................................................................... 14
5.0 Discussion........................................................................................ 16
5.1 Strengths and limitations............................................................... 16
5.2 Study design................................................................................. 17
5.3 Generalizing the results................................................................. 18
6.0 Conclusion....................................................................................... 18

3

/KL.7. Making office workers healthier: A public health intervention making office workers use their height-adjustable office desks more, conducted for LINAK® 2017

1.0 Background

Sedentary behavior and health

There is a broad agreement among clinicians and public health experts that sedentary behavior has negative effects on ourhealth (van Uffelen, et al., 2010; Schmid &Leitzmann, 2014). Prospective studies havefound that sedentary behavior during work
hours increases the risks of both diabetes
mellitus and overall mortality (van Uffelen,
et al., 2010). In addition, a large metaanalysis by Schmid and Leitzmann (2014)
showed an increased risk of certain types ofcancer among individuals with a sedentary lifestyle (Schmid & Leitzmann, 2014).
Further, several studies (van Uffelen, et al.,2010) have found associations between
sedentary behavior and cardiovasculardisease and obesity. In short, the humanbody evolved to move, and we are now
discovering the potential consequences of
having a daily behavior that goes against
our biology.

Sedentary behaviour“The absence of physical activity e.g. prolonged
hours of sitting.” (van Uffelen, et al., 2010)

Why is this a problem? Because the majority in developed countries are sitting down
most of the day, while working, when
watching television, when eating, whentransporting ourselves, etc. We spend up to
12 hours a day sitting, many of these hours
during work (van der Ploeg, Chey, Korda,
Banks, & Bauman, 2012).
A study by Thorp et al. conducted inAustralia among 193 employees in offices,
call centers and customer service showedthat office workers were sedentary 77 % ofworking hours (Thorp, et al., 2012). These

1.0 Background4

2.0 Behavioral
Design3.0 Method

4.0 Results

findings are consistent with findings in other European countries (Ryan, Dali, Granat, &Grant, 2011; Toomingas, Forsman, Mathiassen, Heiden, & Nilsson, 2012). In addition, a
study by McCrady et al. has shown a majordifference in the average time sitting when
at work and during leisure with an averageof sitting down 100 minutes more during
workdays (McCrady & Levine, 2009).

“We spend up to 12 hours
a day sitting, many ofthese hours during work.”(van der Ploeg, Chey, Korda, Banks, & Bauman,2012).

So, we are spending too much time sitting
down during work, which is bad for us,
but many of us engage in physical activity
outside working hours. Can we avoid theadverse effects of sitting down during
work by being active during leisure? Asdevastating as it may sound, studies suggest that high intensity physical activity
doesn’t make up for the adverse healtheffects of sedentary behavior during work
hours. A review by Hamilton et al. foundthat sedentary behavior can lead to adverse
cardiovascular and metabolic effects thatare independent of whether people meetthe general guidelines for physical activity(Hamilton, Healy, Dunstan, Zderic, & Owen,
2008). This claim is supported by anotherstudy where the effects of sitting time onrisk of cancer persists after controlling forphysical activity during leisure time (Schmid& Leitzmann, 2014).

5.0 Discussion

6.0 Conclusion

/KL.7. Making office workers healthier: A public health intervention making office workers use their height-adjustable office desks more, conducted for LINAK® 2017

Sedentary behavior and healthHow can we address this problem?
A large number of workplace interventions
have been carried out and evaluated during
the last decade. Research suggests thatinterventions, that target modifications in
the working environment on the individuallevel, produces the largest reduction in
workplace sitting time (Dunstan, et al.,2013). One effective way of reducing
sedentary behavior at work is by providing
office workers with height-adjustable officedesks. Several studies have been carried out
showing that installing a height-adjustableoffice desk can reduce the hours spent sitting down during work with thirty minutes
to two hours (Shrestha, et al., 2016; Tew,
Posso, Arundel, & McDaid, 2015). In addition, frequent changes in posture whileworking has been associated with a higher
level of productivity (Karakolis & Callghan,2014).

“We cannot change theentire environment inwhich people work, but
we can reduce the hours ofsedentary behavior.”

We cannot change the entire environment
in which people work, but we can reduce

Background

Behavioral
Design

MethodResults

the hours of sedentary behavior and positively impact office workers’ health during
work hours by providing height-adjustableoffice desks. However, a challenge has been
to make office workers integrate the use of
their height-adjustable desks while being
at work.
As one of the world’s leading companies
providing electrical actuator solutions forheight-adjustable office desks, LINAK A/S
has the opportunity of positively influencing
millions of people’s wellbeing and health.
However, a big challenge for LINAK is thatthey are a sub supplier in the value chain.
This means that LINAK is never in directcontact with the office worker of theirheight-adjustable office desks.
So how can LINAK make sure that office
workers will use and keep using theirheight-adjustable desks, when workplaces
are investing in office equipment that has
the potential to improve workers health?
They can’t.
However, this was what LINAK wanted
to investigate – how do we make office
workers use their height-adjustable officedesks more?
Together with /KL.7, one of the leading behavioral design agencies in Europe, LINAK
set out to investigate, design, and test
solutions that could help close the intention/action gap - having a height-adjustableoffice desks, but not using it or only using it
to a small extent.

Discussion

Conclusion

5/KL.7. Making office workers healthier: A public health intervention making office workers use their height-adjustable office desks more, conducted for LINAK® 2017

2.0 Behavioral Design

Objective
The objective of the study was to design
and test interventions that could be integrated or added to LINAK’s current products
to increase time standing up during
working hours among office workers. But
even though it is both in the employers andthe office workers own interest behavioral
compliance tends to remain absent during abusy workday.

“Recommendations foroffice workers that are
mainly desk based are atleast 2 hours/day [...]”(Buckley, et al., 2015)

As described in the Nobel Laurate Daniel
Kahneman’s book “Thinking fast and slow”,
the information alone (“this will do you
good”) rarely brings about the behavior(Kahneman, 2011). The action/intention
gap plays a big part here. Office workers ofcourse have the intention of being healthier
individuals, but throughout their workday,
their limited executive mental functions areused for more – seemingly – urgent matters, than cardiovascular dangers 20 years
ahead (Dolan & et. al., 2010). Therefore,
the prime target for design of interventions
were to figure out how to help the office
workers bridge the action/intention gap in
a busy work day. And in a feasible effortlessmanner.

Background6

Behavioral
Design

MethodResults

Recommendations for office workers thatare mainly desk based are at least 2 hours/
day, of standing and light activity during
work hours. (Buckley, et al., 2015). Of
special interest in this study were office
workers that did not meet this recommendation of standing. These users are definedas ‘light users’ in the current study, and defined as standing 20 % or less time at theirheight-adjustable desk during a work day.

Approach/KL.7’s work is grounded within different
disciplines concerning human behavior e.g.,
behavioral economics, evolutionary psychology, and social psychology. This approachis called behavioral design. In this projecta behavioral analysis was conducted firstly
to address the issue and identify possible
barriers for non-use of height-adjustableoffice desks.
The so called Septigon Model (Koester,2007) was used to structure the analysis.
Using the model consists of exploring aproblem in seven different dimensions all
influencing the behavior in different ways.
The seven dimensions are: 1) Individual,
2) Group, 3) Organization, 4) Society andCulture, 5) Process, 6) Physical space, and
7) Technology.

Discussion

Conclusion

/KL.7. Making office workers healthier: A public health intervention making office workers use their height-adjustable office desks more, conducted for LINAK® 2017

Individual

2.1 Interventions

Technologies

Group

Physical space

Organization

Culture andsociety

Process

Figure 1. Septigon Model
One of the main findings from this analysis
was that there are very few triggers in theworking environment reminding office
workers to stand up while working.

“[...] there are very few
triggers in the working
environment reminding
office workers to stand up
while working.”

This finding was apparent in all sevendimensions of the Septigon Model. As an
example, on the individual level you might
not get any bodily cues, that it is time tostand up, or you might not interpret themas such. For example, when feeling tired orwithout energy, it is from an evolutionary
perspective not logical for you or your bodyto want to stand up and use more energy.
When feeling tired you would want to saveenergy and sit down. However, feeling tired
and without energy is often a sign that you
need to stand up.

Background

Behavioral
Design

MethodResults

Another finding from the behavioral
analysis was that much of the guidancealready given office workers was “perfect”
or expert guidance. But if office workers are
not using their desks at all, standing up for
2 hours/day might be a bit too demanding. Research within habit-formation has
shown that to turn a given behavior into a
habit, the initial behavior needs to be fairly
simple (Fogg, 2017). As Fogg also states,
some habit loops might have an internal
trigger, but a habit rarely starts with internal
triggers. Therefore, the need for building external triggers was the focus of theintervention design. Drawing from patternsof design from external cognition (Donald,1993). Two different strategies were tested
as described below.
In order to address this problem, /KL.7 developed a number of strategies to increase
the users’ awareness, aiming at affecting
the behavior of office workers that could
be implemented as part of LINAK’s current
actuator solutions. Thereby making it possible for LINAK to influence the behavior
of office workers without being in directcontact with them.

Discussion

Conclusion

7

/KL.7. Making office workers healthier: A public health intervention making office workers use their height-adjustable office desks more, conducted for LINAK® 2017

2.1 Interventions

Two different awareness strategies werechosen:• E-mail reminders• Tactile and auditory reminders

The content of the e-mail reminders was
based on different behavioral approacheswith focus on (the numbers indicate how
many e-mails with that particular topic theintervention groups received):• Effectiveness during the day (1),• Energy when you are off work (2),• Social messages involving colleagues (1),• Long-term health benefits (1),• Short-term health benefits (1),• Habit formation (3),• Loss aversion (1),• And a welcome (1) and goodbye e-mail (1)2.2 Intervention sites and period

motivation regarding how and why to standup while working. The e-mails were kept
short and in a personalized style.
E-mails were sent to the intervention
group’s inboxes during working hours. One
e-mail with new content was send eachday. Distribution time varied to make thecontent and action of the e-mail fit the time
for the action, tying the e-mail remindercloser to the moment of the desired action.
For example, participants received an e-mailwith a recommendation to raise their desk
before going to lunch at 11 a.m. so thedesk was raised when coming back after
lunch.

The e-mail was designed so the subject-line
itself promoted the desired action, and themain text provided further information and

For the tactile and auditory intervention,
reminders were placed at the desk for theoffice workers to feel and hear them. The
office workers received a reminder once
every hour. The only information office
workers had prior to the intervention wasthat their desks would remind them ofstanding up every hour, from the morningwhere interventions were implemented.

Three intervention sites in Denmark wererecruited for the study. The recruitment
criterion was that they already had LINAK
actuator solutions installed.

Managers were informed about the project,but office workers were only told that theworkplace had been selected to participate
in a small public health research project.

Workplace 1 had 27 participants, workplace
2 had 21 participants and workplace 3 had
17 participants. Workplace 1 and 2 received
e-mail reminders as intervention andworkplace 3 received tactile and auditory
reminders as intervention.

Background8

Behavioral
Design

MethodResults

Discussion

Conclusion

/KL.7. Making office workers healthier: A public health intervention making office workers use their height-adjustable office desks more, conducted for LINAK® 2017

3.0 Method

The main objective of this study conductedby LINAK and /KL.7 is to increase minutes
standing among office workers that were
not using their height-adjustable office deskor used it less than the recommended time.

Office workers are split into light and heavy
users defined as:

Light users:

20 %Stand upor less of thetotal time registered
Heavy users:
Stand up more than
total time registered

3.1 Study design

Baseline data
(2-3 weeks)

Behavioral
Design

MethodIntervention
implementation

Results▼

The study examines whether office workers
use their height-adjustable office desks
more, equally or less during the intervention period compared to a baseline period(Figure 2).

Figure 2 – Study design

Background

20 % of theInterventiondata(2-3 weeks)

Discussion

Conclusion

9/KL.7. Making office workers healthier: A public health intervention making office workers use their height-adjustable office desks more, conducted for LINAK® 2017

3.2 Data collection

Behavioral data
Software and additional hardware tomonitor behavior was installed during
November and December 2016 at the threeintervention sites. The software was linked
to the office worker’s computer througha USB2LIN06 cable, monitoring whether
the worker was at his or her desk, as wellas the height of the desk at a given time.
A new value was registered each time thedesk was adjusted or the status changed
from active to idle, or idle to active.
Baseline data was collected in December
2016, 2-3 weeks before the interventions
were implemented. The office workers weretold as little as possible about the intervention to avoid changing their behavior
as a result of being monitored (c.f. The
Hawthorne effect).
The intervention period lasted for 3 weeks
for workplace 1 and 3, and 10 days for

The Hawthorne effect:“This effect is generally defined as the problem
in field experiments that X’s’ knowledge that they are
in an experiment modifies their behavior from what it
would have been without the knowledge.”(Adair, 1984)

workplace 2. The intervention data wascollected during January 2017.
Qualitative data
In addition to quantitative behavioral data,
qualitative data was collected. A consultant from /KL.7 observed the use of theheight-adjustable office desks both during
the baseline period and after the intervention period for a period of 3-4 hours foreach visit. After the intervention period,
interviews were also conducted with 16
users to get a qualitative evaluation of theinterventions. It was important to conduct
the interviews after the intervention period,so the interviewer’s questions did not influence the outcome of the interventions.
Themes within the observation guideincluded:1) Physical environment2) Daily work routines
3) Behavioral patterns4) Current interventions already within the 		
workplace5) Identification of possible factors that 		
may lead to biases
Themes within the interview guide:1) Experience with the intervention2) Use of the intervention3) Improvements of the intervention

Reminders work

+ 12

+ 43

min

min

Non-users

Light-users

Reminders increased the participants’ standing time. The standing time of non-users increased by 12 min. Light-users doubled their standing time byadding 43 min per day to their base time, going from 36 min to 79 min of standing per day.

Background10

Behavioral
Design

MethodResults

Discussion

Conclusion

/KL.7. Making office workers healthier: A public health intervention making office workers use their height-adjustable office desks more, conducted for LINAK® 2017

3.3 Data management

Before data was analyzed, it was cleaned
in regard to removing all observations
registered as either: 1) idle, 2) error codes,
3) values not in individual intervals*, 4)data in weekends and holidays, and 5)
Insufficient data due to: individuals with nodata before and/or after the intervention
period; individuals with less than 20 hours
registered in total or less than nine hours
in either baseline or intervention; single
observations > 8 hours (Figure 3).

*Individual intervals for sitting and standing
were calculated for each individual finding
the two normal distributions of the data foreach individual.

Figure 3 – data management

Raw data
23.009Idle cases anderror codes

Ouside individualintervals

10.417363

Observations
removed due toinsufficient data

Weekendsw andvacation
692

2353

Total cases
9184

Baseline

Intervention

5157

Background

Behavioral
Design

Method4533

Results

Discussion

Conclusion

11

/KL.7. Making office workers healthier: A public health intervention making office workers use their height-adjustable office desks more, conducted for LINAK® 2017

3.4 Statistical analyses

The effect of the two interventions wasanalyzed by:• Total time standing in relative terms(i.e. percent of the total time spent by thedesk sitting down/standing up) during an
8-hour workday• Total time standing in absolute terms(minutes sitting down/standing up) during
an 8-hour workday
The distribution of the measurements
was calculated either in relative terms (i.e.
percent of the total time spent by the desk
sitting down/standing up) or in absoluteterms (minutes sitting down/standing up).
To ensure comparability, all measurements
in absolute terms were calculated so thatthey reflect the number of minutes on astandardized work day of 8 hours.
By using the means from these distributions, we can observe how the participants
develop – individually as well as in different
groupings – from the baseline to theintervention period. Since the number ofobservations differ significantly from indi-

3.5 Qualitative insights thatmight affects behavior

Prior to the implementation of the interventions, a consultant from /KL.7 observed the
behavior among workers at the 3 intervention sites to identify possible challenges for
implementing the interventions.
In this regard, several insights were noted:

Background12

Behavioral
Design

MethodResults

vidual to individual, all means are weighted
as to ensure that all individuals’ observations count equally.
When comparing the weighted means, we
account for the statistical uncertainty byconsistently including the 95 pct.-confidence intervals (CI). Only then can we plausibly conclude whether there is a significant
change in the measurements over time ornot. This is also the reason why we visualize
the data in the Appendix A with box plots,
as they – as opposed to bar charts or pie
charts – show a true image of the entire
data distribution.
In the linear regression model the methodof block-recursive modeling is used. By
doing so, we can observe how the introduction of additional variables (e.g. intervention type) affect the overall relationshipbetween baseline/intervention and timestanding up/sitting down, while at the sametime controlling for all other variables.
All analyses and visualizations are conducted in the open-source program R.

1. Some users already stood up most of 		the time
2. Many users already had LINAK® 		
reminder software installed – which
could influence the effect of theinterventions to be tested

Discussion

Conclusion

/KL.7. Making office workers healthier: A public health intervention making office workers use their height-adjustable office desks more, conducted for LINAK® 2017

4.0 Results

4.1 Overall results

The final dataset consists of 9184 valid
observations and 4536 valid hours of sitting and standing, distributed across 54
individuals. Observations, hours and numberof individuals are shown in the table below
for heavy and light users as well as the twodifferent interventions (table 1).

LINAK wanted to investigate whether two
different types of reminders could help office workers stand up more at their heightadjustable office desks. Of special interest
was to affect the behavior among office
workers that stood up working 20 % or lessof the time at their desk (light users).

period (table 2). These results are statistically significant when controlling for othervariables (table 3 – user).

“Light users standing timeincreased from 36,3 min/day in the baseline to78,9 min/day during theintervention.”In this regard, we see very positive results
for these users. Light users standing timeincreased from 36,3 min/day in the baseline
to 78,9 min/day during the intervention.
More than doubling their minutes of standing (table 2). In relative terms, this result
corresponds to standing 7,6 % during
an eight-hour workday in the baseline,
and 16,4 % a day during the intervention

Background

Behavioral
Design

MethodResults

We also investigated whether office
workers not using their height-adjustableoffice desk at all, prior to the intervention(less than 2 % of the time), had had any
additional benefits of the interventions.
We saw that this group had an additionalsignificant effect on their standing timeof 12,3 min/day (table 3 – non-user). This
result means that, on top of the positiveeffect already identifies among light users,
the non-users experienced an even greater
improvement in their standing behavior.
In short, the interventions worked better,the less the office workers stood up in thebaseline period.

“We saw that this group[non-users] had an additional significant effect on
their standing time of
12,3 min/day.”Discussion

Conclusion

13

/KL.7. Making office workers healthier: A public health intervention making office workers use their height-adjustable office desks more, conducted for LINAK® 2017

4.1 Overall results

4.2 Qualitative evaluation

Both interventions increased standing
behavior in light users with no statisticallysignificantly difference between interventions (table 3 – intervention). We also
looked at the effect for heavy users, where
no statistically significant results were

found when controlling for other variables(table 3 – intercept).

Both interventions were positively assessedby office workers. The e-mail reminders
were referred to as easy to read, fun andmotivating, informative, and tying a concrete behavior to a concrete action. Amongthe less positive remarks, office workers
thought it was too few reminders and they
didn’t like that there was no specific patternin terms of when they received the e-mail(e.g., same time a day, or connected to theuse of their desk).

Regarding, remarks for the tactile reminders, reminding users to stand up every
hour, were also positive overall. Here, thereminders could be linked to the LINAKDesk Control reminders, so reminders weretimely, not telling you to stand up, when
you had just stood up for e.g., 20 minutes.

For readers interested in distribution of thedata, boxplots can be found in appendix A.

Table 1 – counts
BASELINE

INTERVENTION

TOTALn(obs.)n(hours)n(individ.)n(obs.)n(hours)n(individ.)n(obs.)n(hours)n(individ.)

Total

5157

2201

54

4533

2335

54

9184

4536

54

Light users

1870

456

25

1673

862

25

2939

1318

25

Heavy users

3287

1745

29

2860

1473

29

6245

3218

29

Light users:
E-mail intervention

1005

266

16

489

252

16

953

518

16

Light users:
Tactile intervention

865

190

9

1184

610

9

1986

800

9

Heavy users:
E-mail intervention

2772

1637

25

2067

1065

25

4937

2702

25

Heavy users:
Tactileintervention

515

108

4

793

408

4

1308

516

4

Background14

Behavioral
Design

MethodResults

Discussion

Conclusion

/KL.7. Making office workers healthier: A public health intervention making office workers use their height-adjustable office desks more, conducted for LINAK® 2017

Table 2 – effect sizes
BASELINE

INTERVENTION

TOTAL

Sitting(min/day)Standing(min/day)Standing(pct.)

Individuals(n)Sitting(min/day)Standing(min/day)Standing (pct.)

Individuals (n)

Total

346.4
(CI:312.4380.3)

133.7(CI:99.5-167.8)

27.8(CI: 20.4-35)

54

346.4
(CI:310.1-382.6)

133.6(CI:97.3-169.9)

27.8(CI: 20.3-35.4)

54Light users

443.7(CI:431.5455.9)

36.3(CI:24.1-48.5)

7.6(CI: 5-10.1)

25

401.1
(CI:357-445)

78.9(CI:35-122.8)

16.4(CI: 8.3-25.6)

25

Heavy users

262.4(CI:219-305.9)

217.6(CI:174.1-261)

45.3(CI: 36.3-54.4)

29

299.2
(CI:247-351.3)

180.8(CI:128.7232.9)

37.7(CI: 26.8-48.5)

29Light users:
E-mail intervention

442.6(CI: 425.9-459)

37.4(CI: 20.7-54)

7.8(CI: 4.3-11.3)

16

394.5
(CI: 332.8425.2)

85.5(CI: 43.9-93.4)

17.8(CI: 9.3-30)

16Light users:
Tactile intervention

445.7(CI: 424.5-467)

34.3(CI: 13-55.5)

7.1(CI: 2.7-11.6)

9

412.9
(CI: 341.7439.3)

67(CI: 35.2-81.9)

14(CI: 8.9-28.3)

9

Heavy users:
E-mail intervention

259(CI: 210.6307.6)

221(CI: 172.6-269)

46(CI: 36-56.1)

25

289.7
(CI: 232.3324.1)

190.6(CI: 133.2-251)39.6(CI: 27.7-51.5)

25

Heavy users:
Tactileintervention

284(CI: 229.6325.2)

196(CI: 154.3-236)

40.8(CI: 32.2-53)

4

358.5
(CI: 301-389.3)

121.5(CI: 102-150.9)

25.3(CI: 15.6-46.9)

4

Table 2 – linear regression model
Effect on Minutes Standing

Effect on Minutes Standing

B

CI

p

B

CI

p

(Intercept)-36.79-87.60 – 14.03.152-33.32-86.40 – 19.75.213

User (Light User)

79.40

4.71 – 154.08

.038

92.58

9.59 – 175.57.030

Intervention (Tactile)-25.10-116.64 – 66.43.584

Non-User (Yes)

12.34

30.01 – 3.84

.040

Observations

54

54

R2 / adj. R2.080 / .063

.092 / .037

Background

Behavioral
Design

MethodResults

Discussion

Conclusion

15

/KL.7. Making office workers healthier: A public health intervention making office workers use their height-adjustable office desks more, conducted for LINAK® 2017

5.0 Discussion

The current study was a pilot study examining whether two different reminders would
increase minutes standing up during work
hours at three different workplaces. We saw
an increase in standing behavior amonglight users - standing at their desk 20% orless at baseline. Both interventions wereeffectively increasing minutes standing up
for light users. Especially for office workers
not using their height-adjustable office deskprior to the intervention.

make office workers use their heightadjustable desks more, is effective. Manyof these studies have had multi-component
interventions with both interventions on anorganizational and individual level (Neuhaus, Healy, Dunstan, Owen, & Eakin, 2014;
Healy, et al., 2013; Danquah, et al., 2016).
A large cluster of randomized interventions
with 19 offices and 317 workers, conductedin Denmark, showed positive results instanding time after the intervention (Danquah, et al., 2016).

Like this study, several other studies havefound that conducting interventions to

5.1 Strengths and limitations

Background16

Behavioral
DesignData collection method
Data was collected through a software
measuring each time an office worker
adjusted his or her desk, and each time theoffice worker’s computer was not in use oraway from the workstation.

tion leaving researches with biased results.
Therefore, it is also a strength that users
were not reminded daily of being measured.
Only when the software and hardware
were installed prior to the baseline datacollection.

There are several strengths using this datacollection method. First, behavioral data
is more accurate than self-reported data,
since users are seldom completely aware of
their own behavior. Second, an accelerometer wouldn’t have been appropriate forthis study, since we are only interested inwhether people stand more or not. Not if
people move more. Third, there is a chancethat having to register your behavior daily(self-report) or wearing an accelerometer
will remind the office worker being in anintervention (cf. the Hawthorne effect). This
itself can affect behavior in a positive direc-

The software is intelligent and will markthe user as “idle” if the computer is not inuse, leaving out the possibility of a person
leaving their computer for hours while theirdesk will be registered as e.g., standing up.
However, if a person is sitting or standingat their desk with their computer switched
off or in sleeping mode, this will not beregistered or registered as “idle”. To adjust
possible bias due to the method of collecting data, a number of steps were taken during data cleaning and statistical analyses asmentioned in the method paragraph.

MethodResults

Discussion

Conclusion

/KL.7. Making office workers healthier: A public health intervention making office workers use their height-adjustable office desks more, conducted for LINAK® 2017

5.2 Study design

The study was designed to use individuals
as their own control. It could have strengthened the study design if each of the threeintervention sites had been complemented
by matched control groups at the same
workplace or similar workplaces. Even
though this was not possible in the current
pilot project, the study design is still considered valid and an effect was found acrossall three workplaces among light users.

“How long does it taketo form a new habit? For
some people, a few weeks
is enough, for other people,
several months are needed
depending on which behavior
is in focus.” (Clear, 2014)
When conducting a study like this, there
are several potential contextual biases if
the intervention groups are too aware ofbeing studied. A possible risk is to increase
the effect size. We aimed at reducing thesebiases through several actions. First, weused a method of collecting data, whereusers were not aware of being measured
daily. Second, prior to the baseline period,
users were told they participated in an in-

Background

Behavioral
Design

MethodResults

tervention regarding their health. Any effectof being part of the intervention itself will
therefore be evident in the baseline datathat would lead to smaller overall effectsizes. This means that the results found in
the current study will unlikely be due to thecontextual factors of how the interventions
were conducted, but only the interventions
themselves.
Behavior is measured over several weeks
since a change in behavior (standing vs.
sitting) changes from day to day as a resultof different work tasks, meetings, and soforth. Is 2-3 weeks then enough to makesure it is an effect of the intervention is
not just random? Yes, it is. A Danish study
found that the number of days needed toobtain a reliable measure for sitting timewas 4.7 days for work when using an accelerometer (Pedersen, Danquah, Petersen,& Tolstrup, 2016). Is 2-3 weeks enough toconclude that the behavior will last after
the intervention period? Here we should
consider the research in habit-formation.
How long does it take to form a new habit?
For some people, a few weeks is enough,for other people, several months are needed
depending on which behavior is in focus(Clear, 2014). In this study, we wanted toaffect a very simple and easy to do action– standing up, with a very simple trigger.
A Danish study of Danquah et al. foundan effect on time standing up also after 3
months. However, further research would beneeded to conclude whether and how longthe effects of these interventions will last.

Discussion

Conclusion

17

/KL.7. Making office workers healthier: A public health intervention making office workers use their height-adjustable office desks more, conducted for LINAK® 2017

5.3 Generalizing the results

Can the results be generalized to otherkinds of workplaces? Yes, this is very
likely, since other similar studies at otherworkplaces have found an effect of theirinterventions (Neuhaus, Healy, Dunstan,Owen, & Eakin, 2014; Healy, et al., 2013;
Danquah, et al., 2016). In addition, an
effect among light users were found at
all three workplaces where there was avariability in work culture, knowledge prior
to the intervention, work assignments, andso forth.
Can the results also be generalized to othercountries and cultures? When conducting

6.0 Conclusion

In this study, conducted by /KL.7 for LINAK
A/S, we found that the two interventions
reminding people to stand up were effective
to do so in office workers, not using theirdesk or using their desk for 20 % or less ofthe time prior to the interventions.
At baseline office workers stood 36.3 min/day while this increased to 78.9 min/day
during the intervention period.
In the longer run this might effectively
improve the health of office workers alreadyhaving a height-adjustable office desk.
Supplementary analysis
Supplementary analysis can be seen inappendix A.

Background18

Behavioral
Design

MethodResults

the behavioral analysis prior to designing
the interventions, it was of great importance to LINAK A/S that the interventions
chosen could be used across markets.
Therefore, interventions rooted in behavioral mechanisms, that are universal for
most people across cultures, were chosen.
Even though it has not yet been tested,
and therefore no definite conclusions canbe made, when working with universal
behavioral mechanisms, it is likely that theintervention would also affect office workers in countries and cultures different fromthe Danish.

Funding
This work was funded by LINAK A/S. The
funders had no role in study design or data
analysis.
Acknowledgements
We would like to thank all the participantsat the workplaces involved and the staff
who took part in the project.
Contact
Publisher: LINAK A/S, LINAK.COM
Author: /KL.7, a leading European behavioral design agency, Copenhagen, Denmark.
www.kl7.dk

Discussion

Conclusion

/KL.7. Making office workers healthier: A public health intervention making office workers use their height-adjustable office desks more, conducted for LINAK® 2017

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Appendix A – Supplementary analysis

Boxplot – effect minutes pr. day

Figure 1 – Whole group

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Figure 2 – Light and heavy users

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Figure 3 – Heavy and light users
split on intervention
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